Switch to Extra-Fine Inhaled Triple Therapy Improves Regional Ventilation to Small Airways in COPD

Asthma inhaler
Asthma inhaler
Switching from non-extra fine multi-inhaler triple therapy to single-inhaler extra-fine inhaled triple therapy improved regional ventilation to the small airways in patients with COPD.

This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.

Switching from non-extra fine multi-inhaler triple therapy (MITT) to extra-fine inhaled triple therapy with beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide (BDP/FF/GB) improved regional ventilation to the small airways in patients with severe chronic obstructive pulmonary disease (COPD), according to research presented at the 2020 CHEST Annual Meeting held virtually, October 18 to 21.

A total of 21 patients with symptomatic severe COPD (mean age, 63.4 years) were enrolled in this open-label exploratory trial. Patients were previously receiving a stable dose of non-extra fine MITT with inhaled corticosteroid/long-acting beta-2 agonist (ICS/LABA) plus a long-acting muscarinic antagonist (LAMA) for 3 months or longer. Patients switched to single-inhaler extra fine triple therapy containing 100 mg BDP, 6 mg FF, and 12.5 mg GB pressurized metered dose inhaler at 2 inhalations twice daily for 24 weeks.

At weeks 12 and 24, investigators performed low-dose computed tomography (CT) scans at total lung capacity and functional residual capacity to identify changes in image-based specific inner airway volume (siVaw), and resistance (siRaw). The investigators also assessed for percent changes in functional respiratory imaging (FRI) parameters from baseline. Correlations were made between FRI indices and pulmonary function tests.

Predominant emphysema on CT scans was demonstrated in 70% of patients. The overall percent change from baseline to week 24 was +22.0% (P <.001) for siVaw and -17.6% (P =.014) for siRaw at total lung capacity. Change in baseline St. George’s Respiratory Questionnaire total score was inversely correlated to siVaw (r= -0.470; P =.042). However, there was no correlation between the change from baseline in forced expiratory volume in 1 second (FEV1) to either siVaw (r= 0.299; P =.214) or siRaw (r=-0.349; P =.143). Switching from a non-extra fine MITT to extra fine BDP/FF/GB was associated with an increase in the peripheral lung deposition of ICS by 19.8%±3.8%, 18.8%±3.4% by LABA, and 13.2%±7.1% by LAMA of the delivered dose.

According to the researchers, the use of “FRI signatures but not FEV1 capture the significant bronchodilation effect occurring after 24 weeks following switch from non-extra fine to extra fine inhaled triple therapy in patients with severe COPD.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Baldi S, Usmani O, Van Holsbeke C, et al. Effect of switching from multi-inhaler non-extra fine to single-inhaler extra fine triple therapy on regional bronchodilation and ventilation in patients with severe COPD. Presented at: CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 1664.